Commentary on sperm DNA fragmentation testing clinical guideline

The study of physiology of reproduction, particularly in mammalian species, experienced glorious times in the second half of the twentieth century. However, with the advent of intracytoplasmic sperm injection (ICSI), the decade of 1990 appeared to forecast the demise of translational research in male reproductive biology. In fact, in its original and subsequent work, Palermo and colleagues showed that ICSI bypassed the process of natural selection of sperm (1). Then, the prevailing hope became that the only need would be merely to obtain one acceptable spermatozoon. The optimism, based on an exponential increase of successful results, has been moderated in the last decade by results indicating that certain sperm characteristics have an impact on the outcomes of assisted reproduction (2). Recent basic research findings have radically transformed our understanding of the biology of fertilization (3), underscoring the importance of cytological processes, e.g. the timing of sperm acrosomal exocytosis (4), in addition to sperm-associated epigenetic factors (5), proteomics (6) and DNA structure (7,8).